Mayor Tory wants ‘The Fix’ in Toronto nursing homes

Impressed by the transformation of a Peel Region dementia unit, Toronto Mayor John Tory has told his staff to explore the possiblity of bringing the same “Butterfly” program to city-run nursing homes.

Tory sent a letter to Toronto’s long-term care general manager Reg Paul, ordering a full examination of Peel’s success, after reading a Star investigation called The Fix. The four-part series detailed a year-long experiment in the Malton Village Redstone dementia unit that tossed out Ontario’s traditional task-focused care, replacing it with laughter, friendship, energy and, love.

Malton Village resident Inga Cherry, 94, walks through the hallway with Geva Lindsay, one of the home’s cleaning staffers.Inga died in early May but her daughter said she was happier in her final months. (Randy Risling / Toronto Star)

CUPE Ontario president Fred Hahn wants Premier Doug Ford to join him for a tour of the Redstone dementia unit. Hahn wants to show Ford how seniors are thriving now that Redstone’s care has been transformed. (CUPE website photo)

Mayor John Tory says he wants city staff to explore the possibility of transforming Toronto’s city-run nursing homes, like Peel region did with its Redstone unit. (Richard Lautens / Toronto Star)

In an interview, Tory said he was captivated by the results — particularly the increase in job satisfaction for Redstone’s workers. Peel staff said data from the first year showed a dramatic drop in staff absenteeism, an annual savings of $55,000.

“I was impressed by the Toronto Star story on a Peel nursing home and the success it has had with the Butterfly model of dementia care,” Tory wrote to Paul, who oversees Toronto’s 10 nursing homes with 2,641 residents and 3,300 full and part-time staff.

“Given the data that Peel Region has on resident and employee satisfaction, I believe it is a program that is worth investigating here in Toronto,” he wrote. “I want Toronto’s long-term care homes to offer the best care for our seniors, including seniors with dementia.

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“While there is no single answer to the complex and sensitive challenge of caring for seniors with dementia, we must not leave any stone unturned in looking for the best available means of caring for them,” he wrote.

Tory said he will request a tour of Redstone, on the Mississauga side of Hwy 427 and Rexdale Blvd.

The Toronto mayor is welcome to visit, said Cathy Granger, Peel’s director of long term care.

“It is difficult to put into words how joyful and positive it is. Seeing is believing,” said Granger. “That said, he better be ready to chat, give a hug and sing a song, because everyone is family on Redstone.”

Instead of rushing to complete tasks, Redstone staffers were trained over the last year to become emotionally open with people in their care so that they would spend time with them, hold hands, listen to stories and help them through memories from traumatic moments long past.

Residents who previously spent their days staring at the floor or watching TV, soon came back to life, in unique ways. Inga Cherry, 94, spent less time alone in her room and in her final months chatted with staff, made friends and baked bread. Christophe Altenor, 85, embraced song. Fred Smith, 89, lost his fear of toiletting by staff after a worker named Kenroy Foxe hugged him.

Fred Hahn, the Ontario president of the Canadian Union of Public Employees, recently visited Redstone and now the union leader wants Premier Doug Ford, the efficiency seeker, to spend an hour with him inside the dementia unit.

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“Come with me and visit it,” Hahn said, offering an open invitation to Ford, whose government licenses and inspects the province’s 630 nursing homes, including those in Toronto.

“Many people are saying (Ford’s) legacy is going to be one of cuts and devastation but if his legacy could be one of providing real change for seniors, that would be a shock and surprise to many,” he said.

Hahn said Redstone shows that life-altering change in Ontario nursing homes is possible.

“We can do better,” he said. “There is proof.”

Year-end data from Redstone found significant declines in antipsychotic drug use, depression, staff sick days and resident falls, all of which improve care and save money. Using a “conservative” estimate, Peel said Redstone’s drop in staff absenteeism saves that one unit $4,230 a month. Redstone is one of six units in Malton Village.

Antipsychotic drugs in long term care cost the taxpayer-funded Ontario Drug Benefit program $17.4 million in 2017-2018. And a single hip fracture costs the public health care system between $24,000 to $28,000 in direct costs, according to the Registered Nurses’ Association of Ontario.

With the mass of boomers hurtling toward their fragile years, the story of Redstone resonated with readers and industry leaders.

“I cried. I was happy. It gave me hope,” said France Gélinas, Ontario’s New Democrat health critic.

The Fix showed that “once residents received attention from staff, they bloomed. They all changed. They had a more fulfilling life, not necessarily longer, but they had the opportunity to be happy. That means a lot, to everybody,” Gelinas said.

While she plans to lobby Christine Elliott, Ford’s new health minister and deputy premier, for the extra staffing needed to succeed with emotion-focused care, Gelinas said families now know what change looks like.

“Before, they knew they wanted their mom treated with love and respect but those words never resonated. With your story, they are much more articulate with what they want for their moms and dads in long term care. This is a huge shift.”

Critics point to the $100,000 start-up cost of the Butterfly program at Redstone, saying the expense plus the cost of needed extra staff could make it unaffordable for private nursing home companies focused on the bottom line. (Butterfly says its programs create $110,000 a year in overall annual savings, based on homes with 30 to 60 residents.)

One privately-owned nursing home chain said it has already signed a contract for its own transformation.

Jill Knowlton, managing director of Primacare Living Solutions, said that in September her company will launch the Butterfly program in its St. Catharines home, Henley House. Previously, it relied on several spiritual and person-centred care programs, Knowlton said.

Primacare, she said, spent two years researching its strategic plan but kept coming back to the British-based Butterfly program, now owned by Salvation Army Australia. After an “inspirational” tour of Redstone in May, Primacare committed to the program, she said. “The excitement was just electric in our room,” Knowlton said. “People know this is the right thing to do.”

Primacare plans to add the program to its two other homes in Brampton and London at a later date, Knowlton said. The company will also be building a 192-bed nursing home in Flamborough, near Hamilton, using the program’s design standards for small units. Knowlton said the new home will be separated into small living areas, each with eight beds.

“This is the springboard for what the future holds and now that Malton Village is able to share its results and more people can go there to see it, I think that will make a difference,” said Knowlton, who sits on the Ontario Long Term Care Association’s board of directors.

The association’s CEO, Candace Chartier, said homes need extra staff, calling on Premier Ford to “give us an infusion of staffing for us to all give emotional, empathetic approaches to care.”

Chartier said many homes already have programs for person-centred care. Mayor Tory said staff gave him a list of these programs used in Toronto homes.

Before its transformation, Redstone staff relied on similar programs. Staff had training in Montessori along with programs offering “gentle” or “holistic” supports for “individualized” care. Redstone also has access to the home’s two workers with specialized dementia training from Behavioural Supports Ontario.

“The missing piece for us was transformational culture change, which can’t be done through training alone,” said Peel long term care manager Ann-Marie Case-Volkert. “Butterfly brings that strong focus on emotional connection. It helps staff and leadership really focus on the emotional well-being of people in their care.”

For emotion-centered care to succeed, a flat-out transformation is needed, said Doris Grinspun, CEO of the Registered Nurses’ Association of Ontario.

“This is not about a Monday, Tuesday or Wednesday program from 5 to 6 p.m.” Grinspun said.

Like others, Grinspun has long fought for change, including fixes to ministry funding formulas. Homes get government money based on resident “acuity” levels, such as incontinence, pressure ulcers, depression or violence. The fewer problems residents have, the less money homes get. Grinspun said her association’s best-practices program in homes has lessened incontinence and pressure ulcers.

“And then the funding is pulled out,” she said. “And when the funding is gone, the staffing has gone with it.

“It’s outrageous. The government needs to make a commitment that they will not just look but will take action on ways that homes are funded so they are not punished when they do good emotional and clinical work.”